The Knee Joint: The Usual Suspect, but Rarely the Perpetrator

In our practice, we see many patients with knee pain. What surprises a great number of these patients, however, is that the source of their problem is rarely the knee itself. Let me explain.

The knee joint is a fairly simple hinge joint, meaning it moves in two directions (bending and straightening). Therefore, except for cases of direct trauma or sports-related injuries, complications at this joint aren’t as common compared to more complicated joints like the shoulder, ankle, or the spine. However, we still see a ton of patients who come in with knee problems. So why does this happen?

The answer is actually related to what’s going on above and/or below the knee. In many cases, the knee is often the suspect or the victim of the mechanical problems that actually exist at the hip or ankle.

For example, people who come in with a diagnosis of patellofemoral pain syndrome, or runner’s knee, or even iliotibial band (IT Band) syndrome have been found to have excessive inwards rotation and motion of the hip, which creates a knee “bowing in” effect during functional activities such as moving from standing to a sitting position.

This constant motion of “bowing in” which originally started at the hip puts excessive stress on the knee and may eventually produce inflammation and pain in that area. If we look at the problem even closer, what we find is that weak hip/gluteal muscles are often the culprit in producing this “bowing in” effect. And while the pain is perceived to be coming from the knee, the actual cause of the problem originated further up at the hip.

Looking further down the chain at the ankle, similar abnormal forces and patterns at this joint can have a negative impact on the knee. Because everything in the chain is connected, a stiff ankle with limited mobility and tight calf muscles can also contribute to that same “bowing in” effect of the knee as previously mentioned. Again, this will produce abnormal stresses through the knee joint and thus create a lot of inflammation and pain at the knee.

The bottom line is this: if you have knee pain, and you didn’t hurt yourself through any sort of direct trauma, then do yourself a favor and get your hips and ankles looked at as well. If you’re unsure of what the cause of your knee pain is or if it’s stopping you from engaging in your regular activities, please book an appointment now with one of our therapists at All Sports Physical Therapy where we can put together a definitive program to get you back to doing whatever it is you love to do, pain-free, without the need for surgery.

By Paul Mostoff, DPT, Chief of Physical Therapy

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